Provider Demographics
NPI:1356824288
Name:NURKO, MIRA MOOREVILLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MIRA
Middle Name:MOOREVILLE
Last Name:NURKO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 ROCKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2147
Mailing Address - Country:US
Mailing Address - Phone:610-304-9072
Mailing Address - Fax:
Practice Address - Street 1:71 ROCKVIEW ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-2147
Practice Address - Country:US
Practice Address - Phone:610-304-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11212103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist